Pneumonia Prevention

Respiratory illness is one of the most common and debilitating illnesses for older adults. Pneumonia can cause severe illness, hospitalization and death. Prevention of pneumonia is very important. But, what is pneumonia?

Pneumonia is an infection of the lungs often causing fluid accumulation, mucous production and inflammation.

Bacterial Pneumonia
Caused by bacterial pathogens, transmitted from person to person.

Viral Pneumonia

Caused by flu or cold virus.

Aspiration Pneumonia

• Generally not witnessed
• 50% occurs during sleep

What does it mean to aspirate?

Aspiration is when food, drink or saliva enters the lungs.  It happens very easily.  Let's take a look at this video.  During the last swallow, you should notice the person aspirate with just a small drop of fluid entering the trachea.  Notice that the person didn't even cough? 

What does pneumonia look like?

Pneumonia can look different for each resident.  It is very individual, but here are some things to look for and report to the Nurse if you see them:

• New or increased shortness of breath
• New or increased cough
• New or increased sputum production
• A rise in body temperature
• Pain with coughing or breathing
• Change in skin colour or temperature
• Change in level of alertness, sleep and energy
• Confusion
• Falls
• Incontinence
• Decreased appetite

So how do we prevent?

1. Immunizations. Pneumovax should be given every 10 years for persons over the age of 65, potentially earlier for those who have compromised immune systems.
2. Good hand washing.  Sounds simple, right?  It is, but most of us still get it wrong.  Before contact with residents and after.  Staff, residents, family, volunteers.  EVERYONE.
3. Good infection control.  If a resident has pneumonia, staff need to wear a mask as part of droplet precautions.  Ask housekeeping staff to pay more attention to affected rooms, shared bathrooms, railings and other common areas.  Have the resident eat seperately at meals.  Droplets can travel a long way, putting tablemates at risk.
4. Good mouth care.  Huh?  Yes, good mouth care.  Remember that 50% of all aspiration pneumonias occur during sleep and that generally they are unwitnessed.  Good mouth care will keep oral bacteria at a minimum and prevent bacteria-ridden saliva from infecting the lungs.  Good oral care before and after meals is also priority.  No toothpaste or mouth rinse if they have trouble swallowing please!
5. Keep them moving.  Residents who have pneumonia or are susceptible need to keep moving.  Even if they do require more rest, try for at least 30 minutes of "up time" twice a day.
6. Keep them hydrated.  Fluid intake is very important.  Offer fluids by mouth and often, using small amounts at a time.  Know the resident's favorite drinks and thicken if necessary.  Monitor fluid balance (that is, how much they've had to drink and how much they've urinated).  Talk to the Nurse about hypodermoclysis as an option to treat mild to moderate dehydration.  Medications may need to be adjusted if someone is dehydrated.
7. Safe feeding techniques. 

•  Ensure that the resident is positioned upright in their chair for meals at 90 degrees.
• Ensure that the resident is alert for meals. Lethargy, or tiredness, during meals is not safe. Check with the RN if in doubt.
• Before starting to feed the resident, ensure their oral cavity is clear of any debris or mucous. Check with the RN if they are very congested, and might require suction.
• When feeding the resident, provide only ½ tsp at a time. Ensure all fluids (even soups) are thickened to the consistency that is prescribed (nectar, honey or pudding).
• Allow the resident a slow pace and lots of time to swallow. Ensure their mouth is empty before offering the next spoon. It may be helpful to offer them an empty spoon in between to elicit another swallow.
• Do not mix flavours with the resident’s meals. Keep all foods separate. A distinct flavour helps the resident better recognize the food in their mouth and swallow safely. (It also makes food more enjoyable!) If the resident still takes a minced diet, make sure that textures are not mixed as this may cause choking.
• If the resident is pursing their lips shut as you approach with a spoon (snout reflex), try a cold spoon kept in ice water on their lips to cue them to open their mouth.
• If the resident starts to cough during meals, stop feeding and report to the RN. If they refuse to eat, try smaller more frequent meals during the day.
• After each meal, even if only a few spoons were taken, use oral swabs to ensure their oral cavity is clear of any debris or mucous.
• Always ensure the resident is upright for at least 45 minutes after eating. The resident has a delayed gastric emptying time that poses risk for them to aspirate.

~Jennifer Burgess RN, BScN, GNC(C)